"Medicine is a social science, and politics is nothing else but medicine on a large scale"—Rudolf Virchow

February 28, 2018

A new wave of flu outbreaks may occur in China in March, but it will be not as serious as the one that hit many parts of the country earlier this winter, an official from the Chinese Center for Disease Control and Prevention said on Tuesday.

Judging from past experience, smaller peaks of the flu are likely next month, triggered by the change of seasons and heavy population flows after the traditional Chinese New Year holiday, Dong Xiaoping, director of the CDC's global public health center, said at a news conference.

"However, it is almost certain the next peak will be smaller than the first," he said.

Mass population migrations - mainly migrant workers going back to their city jobs after the holiday, coupled with students going back to school after the winter vacation - are expected next month, and disease control centers across China are closely monitoring for viruses to forestall major outbreaks, Dong said.

"The National Health and Family Planning Commission and related authorities have made preparations," he said. "Flu outbreaks in China will continue, but it is not possible for them to develop into a major epidemic like the Spanish flu pandemic between 1914 and 1918."

China was hit by its worst flu epidemic in recent years this winter, and respiratory departments at major hospitals in many cities found themselves short staffed. More than 273,000 cases were reported in January on the Chinese mainland, including 56 deaths, according to the National Health and Family Planning Commission.

The number of reported flu cases on the Chinese mainland in January last year was a little over 30,000. It was 23,300 in January 2016.

The commission has said that the peak season would last until the end of January, when school vacations began. Wang Hesheng, vice-minister in charge of the commission, said earlier this month that the intensity of the flu has declined across China.

A new wave of flu could hit China in March, and the public should take precautionary measures, including vaccinations, Zhong Nanshan, head of the National Clinical Research Center for Respiratory Disease in Guangzhou, Guangdong province, said in January.

The new wave may coincide with a wave of human cases of H7N9 bird flu, which is most active between January and March and may have more serious consequences, he warned.

CDC's Dong said on Tuesday that the two types of flu may coexist in March, but there is no sign that H7N9 would occur in a significant number of human cases anything close to the number of seasonal human flu infections.

"It may bring some challenges for disease control and prevention, but please be assured that health authorities are very experienced in dealing with such diseases," he said.

More than 1,500 human cases of bird flu have been reported on the Chinese mainland since 2013, including more than 600 deaths.

Despite high rates of unintentional firearm injuries, and recognition by the National Rifle Association (NRA) that firearm education is important, it is often said that firearm injuries occur primarily among inexperienced users and that firearm safety comes with experience and training. To investigate this contention, we conducted a study in which we hypothesized that firearm use would decline during the dates of NRA meetings — which attract tens of thousands of members from across the United States, including firearm owners and owners of venues where firearms are used (e.g., firing ranges and hunting grounds) — and that firearm injuries would also decline even among experienced users.

We identified emergency department visits and hospitalizations for firearm injuries during NRA convention dates and during identical days in the 3 weeks before and 3 weeks after NRA conventions in a national database of privately insured patients during 2007 through 2015. We estimated the rates of firearm injuries during convention dates versus control dates in a beneficiary-level multivariable linear regression of firearm injury (a binary variable) as a function of indicator variables for convention and control dates, patient age, sex, indicators for calendar week and year, and state fixed effects.

We conducted subgroup analyses according to census region and state-level stratum of gun-ownership rates, hypothesizing that larger reductions in the rates of injury would occur in areas with more firearm use; according to patient sex, hypothesizing that larger reductions would occur among males, who disproportionately attend NRA meetings; and according to whether a convention was held in a beneficiary’s state, hypothesizing that larger reductions would occur when conventions are easier to attend. In addition, we used the National Incident-Based Reporting System to analyze the proportion of crimes involving a firearm that occurred during convention versus control dates.

Additional methods, results, and discussion are provided in the Supplementary Appendix, available with the full text of this letter at NEJM.org.

Among 75,567,650 beneficiary-period observations in the claims analysis, 14.3% occurred on NRA convention dates. The unadjusted rate of firearm injuries was lower during convention dates than during control dates (129 beneficiaries with a firearm injury among 10,883,304 persons [1.19 per 100,000] vs. 963 beneficiaries with a firearm injury among 64,683,254 persons [1.49 per 100,000]; P=0.004; relative difference, 20.1%; 95% confidence interval, 6.7 to 34.0). The findings were unaffected by adjustment for covariates (Figure 1).

Reductions in firearm injuries during convention dates were largest among men, in the South and West, in states in the highest third of gun-ownership rates, and among people who resided in the state hosting the convention. There was no difference in the proportion of crimes involving a firearm between convention and control dates.

These findings are consistent with reductions in firearm injuries occurring as a result of lower rates of firearm use during the brief period when many firearm owners and owners of places where firearms are used may be attending an NRA convention. Our results suggest that firearm-safety concerns and risks of injury are relevant even among experienced gun owners.

During the West Nile virus transmission season (June to November), ECDC publishes weekly epidemiological updates on human West Nile fever cases occurring in the European Union and the neighbouring countries. The updates are available via the Surveillance Atlas of Infectious Diseases. This year, for the first time, ECDC included equine West Nile fever cases in its epidemiological updates. During the 2017 transmission season, 204 human cases and 127 equine cases were reported in the European Union.

Human cases

The first cases in the European Union were infected in Greece late June and were reported at the end of July. The last case of the season was infected in Hungary and was reported mid-November. In the neighbouring countries, the first case was reported by Israel at the beginning of July. The last case of this transmission season was reported by Turkey at the end of November; the case had disease onset early September.

Romania reported a 1.4-fold decrease of human cases compared to the year before. Few affected areas in Romania had no previous reports of West Nile fever cases. Italy also reported cases in newly affected areas, e.g. in Livorno, along the western coast and in the north of the country, in Asti.

After two consecutive years without any West Nile fever cases, in 2017, Greece reported again cases, including in areas where no cases were ever reported before. France reported one case in the Alpes-Maritimes, at the border with Italy, an area where no human West Nile fever cases were reported before. The last time France reported an autochthonous case was in 2015.

Serbia reported a similar number of human cases compared to the previous transmission season (n=41), but more compared to 2015 (n=28). Turkey reported several cases more than the previous year, including cases in areas without previous cases (i.e. in Istanbul and Icel). Considerably fewer West Nile fever cases were reported by Israel compared to the previous years, i.e. 125 and 84 cases in 2015 and 2016, respectively. No West Nile fever cases were documented in Russia this year. In 2016, Russia reported 135 cases.

Equine cases

This year, for the first time, ECDC included equine West Nile fever cases in its epidemiological updates. Equine cases are notified through the Animal Disease Notification System (ADNS) of the European Commission.

Following a One Health approach, the maps including human and equine data aim to highlight areas, at the NUTS 3 level, where West Nile virus circulates in incidental hosts. During the 2017 transmission season 127 equine West Nile fever cases were reported by EU Member States through ADNS: 92 in Italy, 13 in Greece, 13 in Spain, three in Hungary, three in Portugal, two in Austria and one in France.

A Blood Tribe woman was a "sweet girl" and "beautiful soul" who had compassion, understanding and love for family, especially in their darkest times, her cousin says.

The woman died of a drug overdose in Lethbridge on the weekend amid an unusual spike in overdoses. Police believe it was the result of a bad batch of drugs, perhaps carfentanil, triggering what one health official called "an absolute crisis."

The Blood Tribe mother leaves behind two children, aged nine and 10.

CBC News is choosing not to name the family to protect their privacy.

"I'm going to remember her as the sweet girl that she was," said the victim's cousin. "She took her time out of her life despite what she was going through to be there for us in our times of need."

The cousin said her own daughter and the victim left their home on the Blood Tribe for Lethbridge last weekend. On Friday night, she said her daughter overdosed after getting drugs from two men.

Paramedics arrived in time to revive her.

Lethbridge paramedics responded to 15 other overdoses that day, making it the worst day they have ever seen for these calls, according to Dana Terry, deputy chief of fire and EMS operations for the City of Lethbridge.

But the rash of calls wasn't over when the victim took drugs the next day — and died.

"Her aunty ran in there and her aunty turned her over and started doing CPR because she noticed her face was all blue," the cousin said. "They called 911. The paramedics got there, and they worked on her for a while before they could get a pulse…

"They brought her into the hospital. She never woke up again."

There have been more than 50 overdoses in the Lethbridge area in a little more than a week. At least two people have died.

From mid-December 2017 through 3 February 2018, the Ministry of Health (MoH) of Kenya reported 453 cases, including 32 laboratory-confirmed cases and 421 suspected cases, of chikungunya from Mombasa County.

The outbreak was detected due to an increase in the number of patients presenting to health facilities in Mombasa Country with high grade fever, joint pain and general body weakness.

On 13 December 2017, eight blood samples from two private hospitals were collected and submitted to the Kenya Medical Research Institute (KEMRI) arbovirus laboratory in Nairobi. Of the eight samples tested, four were positive for chikungunya and four were positive for dengue by polymerase chain reaction (PCR) analysis.

On 4 January 2018, blood samples were collected from 32 additional suspected cases and sent to the KEMRI laboratory. Of these, 27 samples tested positive and five samples tested negative for chikungunya by PCR.

A large proportion, approximately 70%, of cases reported severe joint pain and high grade fever. The scale of this outbreak has likely been underestimated given the under-reporting of cases and low levels of health-seeking behaviors among the affected population. The large mosquito breeding sites in affected areas and inadequate vector control mechanisms also represent major propagating factors.

Based on reports from peripheral health facilities, the outbreak has spread to the six sub-counties (Changamwe, Jomvu, Kisauni, Likoni, Mvita and Nyali) of Mombasa and one in Kilifi: with the majority of suspected cases reported from Mvita and Likoni in Mombasa.

During the first four weeks of 2018, a rapid increase in the number of confirmed human cases of yellow fever was observed in the states of Rio de Janeiro, São Paulo, and Minas Gerais. From 1 July 2017 through 16 February 2018, 464 confirmed human cases of yellow fever have been reported in Brazil, including 154 deaths. Confirmed cases were reported in São Paulo (181 cases, including 53 deaths), Minas Gerais (225 cases, including 76 deaths), and Rio de Janeiro (57 cases, including 24 deaths) states and in the Federal District (1 fatal case).

Unlike the previous seasonal period, the current seasonal period has been characterized by more cases reported in São Paulo and Rio de Janeiro states along with the occurrence of cases in areas near large cities.

In São Paulo State, 57% of the confirmed cases were likely to have been infected in Mairiporã Municipality (a rural area located 15km north of São Paulo Municipality). In Rio de Janeiro State, 45% of the confirmed cases were among residents of Valença and Teresópolis municipalities; the latter is located 96km from Rio de Janeiro City. Likely places where infections occurred for all of the confirmed cases correspond to areas with documented epizootics in non-human primates. In Minas Gerais, 47% of the confirmed cases reside in municipalities located south and southeast of the city of Belo Horizonte, where no human cases were detected during the outbreak in the 2016/2017 seasonal period.

Two laboratory-confirmed cases of yellow fever (in France and in the Netherlands) have been reported among unvaccinated travellers who stayed in Brazil, in municipalities considered at-risk for yellow fever as described in the international travel health recommendations on the basis of the virus circulation, the distribution of yellow fever vectors and animal reservoirs.

In addition, two laboratory-confirmed cases were reported in Argentinian citizens, likely to have been infected in Ilha Grande, municipality of Angra do Reis, state of Rio de Janeiro, and Isla Bella, state of São Paulo Brazil (both municipalities are known to be at risk for yellow fever). Furthermore, as of 26 February, three confirmed cases of yellow fever (two fatal) have been reported in Chilean citizens likely to also have been infected in Ilha Grande, municipality of Angra do Reis, Rio de Janeiro state, Brazil.

Epizootics have been reported continuously along the yellow fever pre-season and seasonal period, indicating sustained virus circulation in favourable ecosystem, which is expanding to areas previously not considered at risk for yellow fever. From 1 July 2017 through 6 February 2018, 3812 epizootics among non-human primates have been reported of which 517 have been laboratory-confirmed, 1157 remain under investigation, 1397 were classified as indeterminate, and 741 were ruled out. Epizootics have been reported in 22 of the 27 federal areas in the country.

Epizootics with confirmed yellow fever circulation among non-human primates were reported in six states (Espírito Santo, Mato Grosso, Minas Gerais, Rio de Janeiro, São Paulo, and Tocantins). São Paulo has accounted for 42% of the total epizootics.

Additionally, the Brazil Ministry of Health reported the detection of yellow fever virus in Aedes albopictus mosquitoes captured in rural areas of two municipalities (Ituêta and Alvarenga) in Minas Gerais State in 2017 as part of an investigation conducted by the Ministry of Health of Brazil and the Evandro Chagas Institute. The significance of this finding requires further investigation, particularly to confirm vector competence to transmit yellow fever.

Nigeria’s Lassa fever outbreak has reached record highs with 317 laboratory confirmed cases, according to figures released by the Nigeria Centre for Disease Control (NCDC) this week.

Although endemic to the West African nation, Lassa fever has never reached this case count in Nigeria before. The number of confirmed cases during the past two months exceeds the total number of confirmed cases reported in 2017.

The outbreak has affected 18 states since the first case was detected on 1 January 2018, resulting in 72 deaths caused by the acute viral haemorrhagic fever. A total of 2,845 people who have come into contact with patients have been identified and are being monitored.

The World Health Organization is supporting the NCDC-led response with a focus on strengthening coordination (including through the Global Outbreak Alert and Response Network), surveillance, contact tracing, laboratory testing, clinical management of patients, and community engagement. State health authorities are mobilizing doctors and nurses to work in Lassa fever treatment centres.

“The ability to rapidly detect cases of infection in the community and refer them early for treatment improves patients’ chances of survival and is critical to this response,” said Dr Wondimagegnehu Alemu, WHO Representative to Nigeria.

Health facilities are particularly overstretched in the southern states of Edo, Ondo and Ebonyi. WHO is working with health authorities, national reference hospitals and the Alliance for International Medical Action (ALIMA) to rapidly expand treatment centres and better equip them to provide patient care while reducing the risks to staff. Among those infected are 14 health workers, four of whom have died.

“Given the large number of states affected, many people will seek treatment in health facilities that are not appropriately prepared to care for Lassa fever patients and the risk of infection to healthcare workers is likely to increase,” said Dr Alemu.

Health workers are being trained in infection, prevention and control measures, such as the importance of wearing personal protective equipment (PPE) and isolating patients during treatment. WHO has provided an initial supply of PPE, other related materials and is assessing additional needs with a view to addressing them.

WHO is also supporting national response efforts in neighbouring Benin, where more than 20 suspected cases have been reported.

February 27, 2018

The impoverished Pacific nation of Papua New Guinea has been devastated by a 7.5 magnitude earthquake that has claimed at least 16 lives and brought the heartland of the country to its knees.

The earthquake, the strongest ever to hit the country, struck the Southern Highlands, Hela Province and the Western Highlands region early on Monday morning, but the extent of the devastation took days to emerge because of the area’s remoteness.

Southern Highlands governor William Powi said on Wednesday that authorities in his region were still trying to assess the extent of the damage, and his people were traumatized, with the disaster causing “catastrophic havoc and destruction.”

Uvenama Rova, secretary general of the PNG Red Cross, said he had confirmed reports of 11 deaths in the southern highlands region and five in Hela province, though his contacts in the affected regions reported “many” more deaths, entire villages buried under landslips, and mass grieving by affected communities.

The Red Cross also said it knew of houses that had “sunk” in the town of Tari in Hela province, where concrete roads had also been destroyed, bridges snapped and the town’s hospital forced to turn away patients.

Rova said according to information from ExxonMobil, which had mining operations in the affected regions, more than 10,000 families were affected by the quake.

ExxonMobil has suspended its $19bn liquefied natural gas (LNG) plant, the country’s biggest export earner, as dozens of aftershocks continue day and night, including a 5.7 quake on Tuesday afternoon, the US Geological Survey reported.

Information has been hard to come by in the affected regions, as many roads have been blocked by major land slides, and essential services such as power and communications cut to remote villages, with further landslips expected as heavy rain fell overnight.

“This is the largest earthquake we’ve ever had and its right in the centre of our country, and we don’t know how many casualties yet, we are still in the assessment stage,” said Rova.

“But we do know schools and infrastructure are devastated, and normal activities within Tari and Mendi town have shut down.”

A local blogger said there were reports of dozens or even hundreds of people killed in the Southern Highlands regions, though the Guardian and the Red Cross could not confirm those reports.

An alarming heatwave in the sunless winter Arctic is causing blizzards in Europe and forcing scientists to reconsider even their most pessimistic forecasts of climate change.

Although it could yet prove to be a freak event, the primary concern is that global warming is eroding the polar vortex, the powerful winds that once insulated the frozen north.

The north pole gets no sunlight until March, but an influx of warm air has pushed temperatures in Siberia up by as much as 35C above historical averages this month. Greenland has already experienced 61 hours above freezing in 2018 - more than three times as many hours as in any previous year.

Seasoned observers have described what is happening as “crazy,” “weird,” and “simply shocking”.

“This is an anomaly among anomalies. It is far enough outside the historical range that it is worrying – it is a suggestion that there are further surprises in store as we continue to poke the angry beast that is our climate,” said Michael Mann, director of the Earth System Science Center at Pennsylvania State University. “The Arctic has always been regarded as a bellwether because of the vicious circle that amplify human-caused warming in that particular region. And it is sending out a clear warning.”

Although most of the media headlines in recent days have focused on Europe’s unusually cold weather in a jolly tone, the concern is that this is not so much a reassuring return to winters as normal, but rather a displacement of what ought to be happening farther north.

At the world’s most northerly land weather station - Cape Morris Jesup at the northern tip of Greenland – recent temperatures have been, at times, warmer than London and Zurich, which are thousands of miles to the south. Although the recent peak of 6.1C on Sunday was not quite a record, but on the previous two occasions (2011 and 2017) the highs lasted just a few hours before returning closer to the historical average. Last week there were 10 days above freezing for at least part of the day at this weather station, just 440 miles from the north pole.

“Spikes in temperature are part of the normal weather patterns – what has been unusual about this event is that it has persisted for so long and that it has been so warm,” said Ruth Mottram of the Danish Meteorological Institute. “Going back to the late 1950s at least we have never seen such high temperatures in the high Arctic.”

Health workers in Trans-Nzoia County are battling to control cholera outbreak which has claimed four lives and left several others hospitalised.

The outbreak has been reported at densely populated Kipsongo slums within Kitale where several people were taken ill after drinking contaminated water.

Medical Superintendent Wanjala Simiyu confirmed the deaths and said that 21 people are admitted at Kitale County referral hospital.

Dr Wanjala told the Standard that blood samples taken from the affected persons show that the victims are suffering from cholera.

“We have so far confirmed four deaths and 21 other people are undergoing treatment and we hope to contain the condition,” Dr Wanjala told the Standard.

A victim, Martin Wasikoto who the Standard managed to speak to at Kitale referral hospital said he started to develop stomach upsets and diarrhoea after drinking water at a hotel at the slum.

“I started experiencing severe diarrhoea on arrival at home before my wife made arrangement to rush me to the hospital but I’m feeling better after the treatment I’m receiving,” said Masikoto who was admitted at the hospital on Saturday.

Masikoto is among seven people admitted at ward six male wing while others are admitted at the female wing. The Standard was denied permission to speak to the cholera victims.

A team of health workers have pitched tents at Kispongo slum to conduct surveillance and educate dwellers on health issues.